Blood Pressure Control Can Prevent Ventricular Conduction

Heart conduction problems are frequently associated with serious or deadly consequences, such as total heart block or heart failure. Left ventricular conduction disease occurs when the heart’s natural electrical conduction mechanism is blocked. A permanent pacemaker is implanted to mitigate its symptoms, however, there are no proven preventive strategies for this illness.
Emilie Frimodt-Mller, MD, and senior author Gregory Marcus, MD, MAS, used a prospective trial in which individuals with hypertension were randomly assigned to either higher or less aggressive blood pressure (BP) control in a report published May 3, 2023, in JAMA Cardiology. They discovered that intensive blood pressure control is associated with a lower risk of left ventricular conduction disorder, implying that the disease may be prevented.

“This research was motivated by patients who came in with complete heart block where I put in a pacemaker and they asked, ‘Why did this happen to me?'” said Marcus, a cardiologist, electrophysiologist, and UCSF professor of Medicine. “The answer to this question has not been clear, so we wanted to look at the impact that blood pressure might have on the development of their conduction disease.”

The authors conducted a post-hoc analysis of the multicenter Systolic Blood Pressure Intervention Trial (SPRINT) to assess the relationship between BP control and the risk of developing left ventricular conduction disorder. SPRINT originally recruited participants from 102 sites in the United States and Puerto Rico and ran for five years, from November 2010 to August 2015. SPRINT participants were 50-year-old adults with hypertension and at least one other cardiovascular risk factor. Participants who had baseline left ventricular conduction disease, ventricular pacing, or ventricular pre-excitation were not included in the study.

Participants were randomly allocated to either regular blood pressure control (systolic blood pressure less than 140) or aggressive blood pressure control (systolic blood pressure less than 120). The scientists evaluated the participants’ serial ECGs as part of the study and discovered that those randomly assigned to the more aggressive BP management had considerably less conduction damage on the left side of the heart.

“This analysis suggests that more aggressive BP control might be a way to prevent this sort of common disease,” said Marcus. “More broadly, the use of randomized controlled trial data provides compelling evidence that this common disease is not an immutable fate, but that the risk can be modified.”

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